Healthcare Provider Details

I. General information

NPI: 1154123693
Provider Name (Legal Business Name): MRS. ERICA DELORES LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1367 GABLE LN
SOUTH EUCLID OH
44121-3667
US

IV. Provider business mailing address

1367 GABLE LN
SOUTH EUCLID OH
44121-3667
US

V. Phone/Fax

Practice location:
  • Phone: 216-903-4193
  • Fax:
Mailing address:
  • Phone: 216-903-4193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: